Multicenter feasibility of integrative health coaching for back pain after an emergency department discharge

The National Center for Complementary and Integrative Health awarded Vanderbilt University Medical Center $624,778 on August 31, 2026, under the Research and Training in Complementary and Integrative Health program (CFDA 93.213) to conduct a multicenter feasibility clinical trial evaluating integrative health coaching for chronic low back pain in emergency department patients after discharge.

The trial will test a randomized controlled design across multiple sites to assess whether remote integrative health coaching—a self-management intervention tailored to individual patients and combining evidence-based complementary and conventional strategies—can improve pain-related outcomes and reduce opioid use and return ED visits among patients with acute exacerbation of chronic low back pain. Current practice shows that up to 60 percent of ED patients with acute chronic low back pain are prescribed opioids, yet fewer than 5 percent receive evidence-based biopsychosocial interventions to promote self-management after discharge. The research team will apply preliminary single-site trial experience and existing ED research infrastructure to address the evidence gap on health coaching as a post-discharge ED treatment option.

Work will be performed in Forest Hills, Tennessee, with a period of performance running from August 31, 2026, through July 31, 2029. The award is classified as a Project Grant under the NIH assistance type structure and represents the first budget period obligation to Vanderbilt University Medical Center, which serves as the prime recipient.

Abstract

This feasibility clinical trial is being proposed to contribute to our research team's longer-term goal of establishing effective biopsychosocial interventions for pain that can be integrated within the emergency department (ED) setting. Chronic low back pain (LBP) is a challenging condition for ED providers to manage and often CO-exists with medical and psychological conditions, which complicates recovery. Despite growing support for a biopsychosocial assessment and management approach as first-line chronic pain treatment, up to 60% of ED patients with acute exacerbation of chronic LBP are prescribed opioid medications. Less than 5% of these patients receive an evidence-based biopsychosocial intervention to promote self-management after discharge and reduce prolonged opioid use and return ED visits. Integrative health coaching is a self- management intervention that is tailored to the individual patient and has shown promise for improving chronic LBP and disability. Evidence is lacking on the benefits of health coaching as an ED option. Integrative health coaching supports patients in actively managing LBP and associated comorbidities with evidence-based complementary and conventional strategies, but remote interventions applying integrative health coaching as a post-discharge ED treatment approach have been insufficiently studied. IT is critical that ED providers have an evidence-based nonpharmacological strategy that can be offered after ED discharge to improve meaningful pain-related outcomes. Given our research team's expertise in optimizing biopsychosocial pain interventions and in testing health coaching for chronic conditions, our existing ED research infrastructure, and our preliminary experience with a single-site trial, we are uniquely prepared to conduct this multicenter 2-armed randomized controlled trial. The overall purpose of the proposed project is to assess the multicenter feasibility of our integrative health coaching program provided in combination with usual ED care (COACH-ED) VS usual care alone for adult patients presenting to the ED with acute exacerbation of chronic LBP. Our main aims are to assess 1) the feasibility of our multicenter trial methodology, 2) the feasibility and acceptability of our COACH-ED intervention, and 3) patient and provider perceptions of intervention implementation, delivery, and benefits. The findings from this feasibility clinical trial will fill important gaps in the existing scientific knowledge and are crucial for planning and conducting the subsequent efficacy trial. Our study will be a pivotal step in advancing understanding of a biopsychosocial model of care that could reduce reliance on opioids among ED patients and in finalizing the methods and infrastructure for our future randomized controlled efficacy trial.